Early Survivorship of Newly Designed Highly Porous Metaphyseal Tibial Cones in Revision Total Knee Arthroplasty
Background: Metaphyseal cones provide durable fixation in revision total knee arthroplasty (TKA). However, there is a paucity of data on the outcomes of a new porous cone design. As such, the goal of this study was to analyze the early survivorship in patients undergoing revision TKA with this cone....
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doaj-283f564d33f64a478488563c8f2ad9b32021-05-16T04:23:54ZengElsevierArthroplasty Today2352-34412021-04-018510Early Survivorship of Newly Designed Highly Porous Metaphyseal Tibial Cones in Revision Total Knee ArthroplastyBrian P. Chalmers, MD0Christina M. Malfer, BS1David J. Mayman, MD2Geoffrey H. Westrich, MD3Peter K. Sculco, MD4Mathias P. Bostrom, MD5Seth A. Jerabek, MD6Corresponding author. Department of Orthopedic Surgery, Adult Reconstruction and Joint Replacement, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, USA. Tel.: +1 212 774 2302x816 808 6348.; Department of Orthopedic Surgery, Adult Reconstruction and Joint Replacement, Hospital for Special Surgery, New York, NY, USADepartment of Orthopedic Surgery, Adult Reconstruction and Joint Replacement, Hospital for Special Surgery, New York, NY, USADepartment of Orthopedic Surgery, Adult Reconstruction and Joint Replacement, Hospital for Special Surgery, New York, NY, USADepartment of Orthopedic Surgery, Adult Reconstruction and Joint Replacement, Hospital for Special Surgery, New York, NY, USADepartment of Orthopedic Surgery, Adult Reconstruction and Joint Replacement, Hospital for Special Surgery, New York, NY, USADepartment of Orthopedic Surgery, Adult Reconstruction and Joint Replacement, Hospital for Special Surgery, New York, NY, USADepartment of Orthopedic Surgery, Adult Reconstruction and Joint Replacement, Hospital for Special Surgery, New York, NY, USABackground: Metaphyseal cones provide durable fixation in revision total knee arthroplasty (TKA). However, there is a paucity of data on the outcomes of a new porous cone design. As such, the goal of this study was to analyze the early survivorship in patients undergoing revision TKA with this cone. Methods: We retrospectively reviewed 163 revision TKAs with a newly designed porous tibial cone from 2016 to 2018. Mean age was 67 years, and mean body mass index was 33 kg/m2. Minimum follow-up duration was 2 years. Most patients were revised for aseptic loosening (46%), 2-stage periprosthetic joint infection (PJI) reimplantation (28%), or instability (15%). Most were varus-valgus constrained (65%) or hinged (32%) constructs. The majority had hybrid tibial stem fixation (74%). A multivariate Cox regression analysis was used to identify risk factors for reoperation. Results: Survivorship free from re-revision for aseptic loosening, any nonmodular revision, and any reoperation was 100%, 96%, and 86% at 2 years, respectively. No patients were revised for aseptic loosening. Six (4%) tibial cones were removed for PJI, one of which was loose. There were 23 reoperations (14%), most commonly for PJI (10%). Multivariate analysis identified PJI reimplantation (hazard ratios [HR] = 4.2, P = .002), males (HR = 2.9, P = .02), and hinged constructs (HR = 2.7, P = .02) as significant risk factors for reoperation. Conclusions: In a complex revision TKA cohort with a new highly porous tibial cone, in which most patients received hybrid stem fixation and nonlinked and linked constraint, there was 100% survival free from re-revision for aseptic loosening at 2 years. Longer term follow-up is required.http://www.sciencedirect.com/science/article/pii/S2352344121000042revision total kneeTotal kneeAseptic looseningMetaphyseal conesStems |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Brian P. Chalmers, MD Christina M. Malfer, BS David J. Mayman, MD Geoffrey H. Westrich, MD Peter K. Sculco, MD Mathias P. Bostrom, MD Seth A. Jerabek, MD |
spellingShingle |
Brian P. Chalmers, MD Christina M. Malfer, BS David J. Mayman, MD Geoffrey H. Westrich, MD Peter K. Sculco, MD Mathias P. Bostrom, MD Seth A. Jerabek, MD Early Survivorship of Newly Designed Highly Porous Metaphyseal Tibial Cones in Revision Total Knee Arthroplasty Arthroplasty Today revision total knee Total knee Aseptic loosening Metaphyseal cones Stems |
author_facet |
Brian P. Chalmers, MD Christina M. Malfer, BS David J. Mayman, MD Geoffrey H. Westrich, MD Peter K. Sculco, MD Mathias P. Bostrom, MD Seth A. Jerabek, MD |
author_sort |
Brian P. Chalmers, MD |
title |
Early Survivorship of Newly Designed Highly Porous Metaphyseal Tibial Cones in Revision Total Knee Arthroplasty |
title_short |
Early Survivorship of Newly Designed Highly Porous Metaphyseal Tibial Cones in Revision Total Knee Arthroplasty |
title_full |
Early Survivorship of Newly Designed Highly Porous Metaphyseal Tibial Cones in Revision Total Knee Arthroplasty |
title_fullStr |
Early Survivorship of Newly Designed Highly Porous Metaphyseal Tibial Cones in Revision Total Knee Arthroplasty |
title_full_unstemmed |
Early Survivorship of Newly Designed Highly Porous Metaphyseal Tibial Cones in Revision Total Knee Arthroplasty |
title_sort |
early survivorship of newly designed highly porous metaphyseal tibial cones in revision total knee arthroplasty |
publisher |
Elsevier |
series |
Arthroplasty Today |
issn |
2352-3441 |
publishDate |
2021-04-01 |
description |
Background: Metaphyseal cones provide durable fixation in revision total knee arthroplasty (TKA). However, there is a paucity of data on the outcomes of a new porous cone design. As such, the goal of this study was to analyze the early survivorship in patients undergoing revision TKA with this cone. Methods: We retrospectively reviewed 163 revision TKAs with a newly designed porous tibial cone from 2016 to 2018. Mean age was 67 years, and mean body mass index was 33 kg/m2. Minimum follow-up duration was 2 years. Most patients were revised for aseptic loosening (46%), 2-stage periprosthetic joint infection (PJI) reimplantation (28%), or instability (15%). Most were varus-valgus constrained (65%) or hinged (32%) constructs. The majority had hybrid tibial stem fixation (74%). A multivariate Cox regression analysis was used to identify risk factors for reoperation. Results: Survivorship free from re-revision for aseptic loosening, any nonmodular revision, and any reoperation was 100%, 96%, and 86% at 2 years, respectively. No patients were revised for aseptic loosening. Six (4%) tibial cones were removed for PJI, one of which was loose. There were 23 reoperations (14%), most commonly for PJI (10%). Multivariate analysis identified PJI reimplantation (hazard ratios [HR] = 4.2, P = .002), males (HR = 2.9, P = .02), and hinged constructs (HR = 2.7, P = .02) as significant risk factors for reoperation. Conclusions: In a complex revision TKA cohort with a new highly porous tibial cone, in which most patients received hybrid stem fixation and nonlinked and linked constraint, there was 100% survival free from re-revision for aseptic loosening at 2 years. Longer term follow-up is required. |
topic |
revision total knee Total knee Aseptic loosening Metaphyseal cones Stems |
url |
http://www.sciencedirect.com/science/article/pii/S2352344121000042 |
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